Court Rulings
- The Department of Health and Human Services (HHS) appealed portions of the injunction on the program integrity rule, specifically the AV de minimis provision. HHS requested for the injunction to be lifted by September 5th. If the injunction is not lifted, HHS would allow for plan changes to ensure that plans ensure compliance with the smaller de minimis window. HHS indicated that further guidance will be released next week (September 8th) should refilings be needed.
- A federal appeals court has ruled that many of the Trump Administration’s tariffs were illegal. However, the ruling does not pause the current imposition of tariffs or require tariff rebates. The ruling will not go into effect until October 14th, giving time for the Trump Administration to appeal to the Supreme Court.
CMS
- Hardship Exemption – HHS announced that for Exchanges for which HHS operates hardship exemptions (and therefore determinations for eligibility for catastrophic plans) that they are expanding the criteria. For all states except California, Connecticut, Maryland, and the District of Columbia, individuals who are ineligible for “Advance Premium Tax Credits (APTC) or Cost-Sharing Reductions (CSRs) due to their projected annual household income being below 100 percent of the federal poverty level (FPL) or above 250 percent of the FPL3F 4 will be eligible for a hardship exemption and enrollment in catastrophic coverage.
- CMMI – CMMI announced that the AHEAD model will undergo changes. CMMI previously published that its demonstrations would embrace 3 pillars: increasing patient engagement, leveraging data and technologies/tools, and protect tax payers.
